| NPI | 1861847741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60691222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33551) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2026-09-03 |